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(Moscow) - Russian authorities on April 5, 2013, released a young woman with a severe health condition after three months in pretrial detention. She was inappropriately held and denied adequate healthcare and medical treatment. The authorities should ensure that she gets the treatment she needs and compensate her for the violations of her rights that caused pain and suffering.

On December 11, 2012, officials from Russia's drug enforcement administration arrested Margarita Charykova, 25, who was born without part of her lower intestine, for allegedly manufacturing methamphetamine in her home. On December 15, Moscow's Timeriazov District Court charged Charykova with the manufacture of narcotics for sale and ordered her detained during the investigation. During her detention, Charykova received no effective medical treatment and her health deteriorated severely. The authorities released Charykova on April 5 and transferred her directly to a government health clinic with specialists available to treat her condition.

"Why would a court send someone to pretrial detention when they clearly have a serious medical condition, and why would prison officials let her health deteriorate so drastically?" said Andrea Mazzarino, research fellow on Russia at Human Rights Watch. "It is a huge relief to Charykova and her family that she was released, but the authorities need to make sure she gets proper and ongoing care, particularly given how badly her health declined in detention."

To manage her condition, Charykova follows a strict diet and takes Paracet to alleviate pain. Her lawyer, Svetlana Sidorkina of the Russian human rights organization Agora, told Human Rights Watch that officials in charge of Charykova's detention at Moscow pretrial detention facility No. 6 refused to provide her with an adequate diet and medical care. As a result, her health deteriorated precipitously and Charykova was in constant pain for the three months she was held.

From February 9 to March 10, doctors at prison hospital No. 1 treated Charykova for a blocked digestive system, infection, and bloating. Charykova was then transferred back to the pretrial detention center, where authorities still refused to accommodate her special diet, causing her condition to deteriorate again. Prison officials also did not provide Charykova with treatment to effectively treat her other symptoms, Sidorkina said. Officials gave Charykova the medication Baralgin, but it was not strong enough to alleviate her pain.

While in detention, Charykova reported to Sidorkina that she had pain in her kidneys, constipation, painful spasms in her intestines, and bleeding from her anus. She also reported that her colon was protruding from her anus. Charykova also said she could not sleep and was afraid to eat due to constant abdominal pain. She also experienced headaches, chest pains, and numbness in her legs, which she attributed to a pinched nerve in her spine. Sidorkina told Human Rights Watch that Charykova's abdomen was extremely swollen, and her weight had increased by more than 25 percent due to blockage in her digestive system.

Under international standards, pretrial detention should only be used when it is absolutely necessary to ensure the integrity of the criminal proceedings. In all circumstances, anyone in pretrial detention enjoys the presumption of innocence and is to be treated with humanity and respect for human dignity. The rights of those detained are enshrined in an array of international human rights treaties to which Russia is a party, including the European Convention on Human Rights (ECHR), the International Covenant on Civil and Political Rights (ICCPR), and the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT).

Authorities are obliged under international law to provide all detainees with at least the level of healthcare available in the community, as well as access to essential medicines such as morphine for pain relief. The European Court of Human Rights (ECtHR) has repeatedly stated that countries have a duty to ensure that the health and well-being of a detainee are adequately secured by, among other things, providing them with the requisite medical assistance. The ECtHR has also on several occasions ruled that a lack of appropriate medical care may constitute cruel or inhuman treatment in violation of article 3 of the ECHR, including in several cases against Russia [Khudobin (2006), Bitiyeva and X (2007),Vasyukov (2011), and A.B. (2011)]. Failure to provide pain treatment in particular may amount to cruel treatment.

Sidorkina told Human Rights Watch that no pretrial detention facility or prison in Moscow has a license to provide medical services in proctology.

"In denying Charykova essential treatment for her very serious health problems, the Russian authorities subjected her to pain and suffering, in a manner that is strictly prohibited under international law," Mazzarino said.

On March 7 Sidorkina filed a complaint with the ECtHR asking it to take interim measures to protect Charykova's life and health under the court's Rule 39. On March 29 the ECtHR sent questions to the Russian government asking it to provide evidence that Charykova had been provided medical care. Russia was obligated to respond to the ECtHR by April 2. Sidorkina has not been informed if the government has replied to the ECtHR.

The Russian government has regularly failed to respect international norms and ECtHR rulings related to the provision of medical treatment to detainees. For example, in November 2007 the ECtHR issued an interim measure ordering Russia to immediately secure HIV treatment for a pretrial detainee, Vasily Aleksanyan, and had to remind Russia to comply three times in the following year.

A March 4 statement to the United Nations Human Rights Council by Juan Mendez, the special rapporteur on torture and other cruel, inhuman, or degrading treatment or punishment, affirms that governments violate the prohibition on inhuman and degrading treatment guaranteed under the ICCPR when they fail to refrain from interfering with healthcare services, and thus condemn patients to unnecessary suffering from pain.

In addition, the UN Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment stipulate that all detainees must be treated "in a humane manner and with respect for their inherent dignity of the human person" (principle 1), and that free "medical care and treatment shall be provided whenever necessary" (principle 24).

"The authorities have blatantly violated Charykova's rights throughout this horrific ordeal, and should compensate her," Mazzarino said. "If she is found guilty in a fair trial, the courts should only order a prison sentence if there are absolute guarantees that she will get the diet and medical care she needs in prison."